Tag Archives: Dentists

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A curious case of ‘lost’ dentures after surgery

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If you’re scheduled to have surgery, there are lots of things you’re likely thinking about. From the seriousness of the procedure and recovery time to hospital bills and who will take care of your home and loved ones while you’re recovering, there is no shortage of things to think about and plan for.

But one thing you may not have put on your list of items to take care of? Taking out your dentures before going under anesthesia.

According to a new report, one 72-year-old man who had abdominal surgery in England actually swallowed (yes, swallowed!) his dentures during the procedure. They got stuck in his throat and were discovered eight days later.

The initial procedure the man was admitted for was to remove a benign lump in his abdominal wall. But because of the denture issue, he was experiencing severe pain, bleeding and swallowing difficulties. The man endured repeated hospital visits over the course of several weeks, additional invasive tests and blood transfusions before the discovery was made.

He also required two additional operations.

False teeth or dental plates present in patients should be clearly documented before and after any surgery, said Dr. Harriet Cunniffe, lead author of a case study on the elderly patient’s ordeal. Dr. Cunniffe is an ear, nose and throat specialist with James Paget University Hospitals NHS Foundation Trust in Great Yarmouth, England.

According to reports, six days after the man’s surgery, he was transported to the emergency department of a local hospital. But doctors there concluded that the bleeding in his mouth, swallowing difficulties and pain were due to a respiratory infection and side effects from having a tube down his throat during surgery.

He was prescribed mouthwash, antibiotics and steroids, and sent home. Two days later, he returned to the emergency department with worsening symptoms. He told doctors he hadn’t been able to swallow any of his prescribed medicines.

At this point, he was readmitted to the hospital. Tests revealed a semi-circular object resting across his vocal cords and that was the cause of the internal swelling and blistering. When the discovery was made, the man said that his dentures were lost during his previous hospital stay for his abdominal surgery.

Doctors operated to remove the dentures and kept him hospitalized for six days. However, he returned a number of times over the next few weeks because of bleeding. Doctors eventually determined that the bleeding was due to internal wound tissue around the blistering caused by his false teeth. They cauterized the tissue to prevent further bleeding.

But the hospital still hadn’t seen the last of him. He returned nine days later with more bleeding caused by a torn artery in the wound. At that time, emergency surgery was scheduled.

Over the next six weeks, however, his tissue healed, he did not require any more emergency care, and his blood count returned to normal.

This isn’t the first documented case of dentures being inhaled while a patient is under general anesthetic.

In the United Kingdom, there are no national guidelines on how dentures should be managed during anesthesia, although this may change in light of this most recent case. In the U.S., The American Dental Association offers guidelines for how dentures are to be handled for surgeries.

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September is Healthy Aging Month: Proper oral care helps seniors age well

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How essential is having a healthy mouth to your physical health? According to many medical experts, you really can’t be in peak physical condition if your oral health isn’t what it should be.

Dentists who are aware of this correlation tell their patients to think about their mouths as the “gateway to wellness.”

No matter how many trips you’ve made around the sun, good oral health is important to your overall quality of life.

From being able to chew food properly and without pain to tasting what you’re chewing, good oral health reduces the likelihood of developing other health issues. For seniors, maintaining oral health becomes even more important. This is because as people age, they become more susceptible to diseases.

Recent studies have shown that the correlation between oral health and overall body health is closer than what was previously believed. According to a recent study, the Centers for Disease Control and Prevention reports that gum disease increases with age, and 70% of adults 65 years and older are affected. Some risk factors for gum disease are:

  • Crooked teeth
  • Stress
  • Defective fillings, crowns, bridges, dentures
  • Taking medications that cause dry mouth
  • Diabetes
  • Heredity
  • Smoking

Research also links gum disease to other conditions such as heart disease, stroke, diabetes, and pneumonia. Preliminary reports suggest that gum disease may be linked to Alzheimer’s.

Decay and oral cancers can also become more prevalent with age. One out of every four persons aged 65 and older has dental decay. The National Institute of Health reports oral cancer rates for adults aged 60-69 is 33.9% and those aged 70+ is 40.2%.

How Can Dentists Help Their Patient Age Well?

There will be 74 million older adults — those who are 65 years of age and older — in the United States by 2030, according to Oral Health America’s A State of Decay, Vol. III report (2016). With larger parts of the U.S. population getting older, dentists will need to consider if they are prepared to properly serve their aging patients.

With the aging of a dentist’s patient base come a number of unique challenges an older individual may face — challenges that dental professionals must be ready to address as well. These include increased medical complexities, lack of dental insurance, reduced mobility and cognitive function, just to name a few.

Participation from the entire dental team is necessary to ensure that patients are well-educated and equipped for optimal oral health, even into old age.

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New tooth sheriff in town: ADA names new president

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The American Dental Association (ADA) recently installed its 156th president. The position was awarded to Dr. Chad P. Gehani of Queens, New York. Dr. Gehani and the new and returning officers were installed in their offices before proceedings of the ADA House of Delegates at the ADA FDI World Dental Congress in San Francisco. The meeting was the 160th annual meeting of the ADA.

During his first address to the House of Delegates, Dr. Gehani told members it is his “responsibility to ensure that the ADA remains the guardian of your lifetime commitment to the profession — and I am not just talking about your dues dollars. The ADA must be a responsible custodian of your time as volunteers and of your talents as clinicians, researchers and educators. The ADA must be relevant to all of us,” he concluded.

Get to Know Dr. Gehani

Dr. Gehani received his dental degree from Columbia University College of Dental Medicine. He is the recipient of the Ellis Island Medal of Honor, which recognizes Americans who dedicate their lives to the community and is bestowed by the Ellis Island Honor Society.

When 24-year-old Dr. Chad P. Gehani arrived at the airport in Mumbai, India, in 1975, he had never even seen an airplane before, let alone flown on one. Dr. Gehani held a one-way ticket to New York City. He had a dental degree from the Government Dental College and Hospital Mumbai, but no guarantee of any job in the United States — especially one in dentistry — and was leaving behind all his family and friends.

Within days of arriving on American soil, Dr. Gehani found a job on Fifth Avenue and 28th Street as a janitor. He was paid $3.75 an hour to unload trucks and clean the streets, warehouse and toilets.

Three months later, Dr. Gehani secured a job in a hospital working as a dental assistant and began taking the national board of dental examinations, which started him down the path that would allow him to be recognized as a dentist in the United States.

Nine months later, he was allowed to begin practicing dentistry. Dr. Gehani joined the American Dental Association in 1977, and five years after he arrived in New York, he became an American citizen.

Watch for a full account of Dr. Gehani’s House of Delegates address on ADA.org and in the ADA News.

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To dental groups’ chagrin, federal sealant measure might be removed

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Sealants prevent cavities in kids. Science says so.

So why is the Health Resources and Services Administration (HRSA) proposing a watered-down measure, titled “Primary Caries Prevention Intervention as Offered by Primary Care Providers, Including Dentists,” that would take the place of current recommendations on sealants for kids?

That’s what the American Dental Association (ADA) and the American Academy of Pediatric Dentistry (AAPD) would like to know!

Leaders from both organizations sent a letter Aug. 27 to the HRSA in response to a proposed change to the current sealant measures.

“We are writing to express our concerns about the proposed replacement of the Dental Sealants for Children Between 6-9 Years measure,” ADA President Jeffrey M. Cole, ADA Executive Director Kathleen T. O’Loughlin, AAPD President Kevin Donly and AAPD Chief Executive Officer John S. Rutkauskas wrote in the letter. “Research has shown that sealants are effective in preventing occlusal carious lesions in the molars of children when compared with controls without sealants.”

The letter points to an evidence-based clinical practice guideline released in 2016 by the ADA and AAPD that found sealants could minimize the progression of cavities in permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes.

“There is in fact evidence to suggest the superiority of resin-based fissure sealants over fluoride varnishes applied to prevent decay in permanent molars,” the letter stated. “While both topical fluoride, as well as dental sealants, are important caries preventive modalities, we fail to see the agency’s rationale for removing the focus on improving sealant rates, especially given the improvement health centers have made.”

As reported by 1,362 administration-funded health centers, their performance improved more than 10% between 2015 –– when the sealant measure was first adopted –– and 2018.

Nearly 53% of children 6 to 9 years old who are at an elevated risk for caries received the recommended sealants. Thirty-six states also have performed better by at least 5% on the measure from 2015 to 2017.

The HRSA explained its rationale in a letter to health centers, stating the fluoride varnish measure would increase the target population from high-risk children who are 6 to 9 years old to children and adolescents as old as 20 and include oral health preventative measures that health centers without dentists can employ.

“The application of fluoride varnish to the teeth of children reduces the risk of development of caries,” the administration stated. “Increasing the use of non-dental providers (i.e., primary care providers) providing fluoride varnish to their patients can reduce the incidence of caries and promote better oral health.”

However, the fluoride varnish measure would track only one application of varnish during the measurement period, contrary to evidence-based guidelines that state topical fluoride should be applied every three to six months in children at an elevated risk for cavities.

The ADA and the AAPD are encouraging the HRSA to only consider metrics that are supported by strong scientific evidence and further tested for validity, feasibility, reliability and usability. The officials noted the sealant measure was developed and tested by the Dental Quality Alliance, an entity convened by the ADA that maintains the measure through a periodic review process to align it with emerging science and implementation experience.

“The use of measures that have not been adequately tested undermines confidence in measures among providers and consumers of health care,” the letter concluded.

Updates on this issue can be found at ada.org.

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Dental students in Costa Rica design metal saliva ejector to reduce waste

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I feel the urge to use the phrase “going green” to describe what a few dental students have accomplished, but since we’re talking about teeth and oral hygiene, I’ll resist the urge.

Let’s just say this group of dental students has engineered a solution to the wastefulness of one-time use plastic saliva ejectors that most U.S. dentists use daily. Dentists must dispose of plastic saliva ejectors after each patient in accordance with infection control protocols.

But thanks to the ingenuity of these conservation-minded dental students, this could become a thing of the past.

The four students at the University of Costa Rica (UCR) have developed a metallic saliva ejector that can be cleaned in the autoclave and reused again and again.

For example, the team estimated that the UCR Faculty of Dentistry throws away 166 ejectors each day, 3,317 each week, and almost 4,000 each year.

The students also note that if the average dental office sees 12 patients a day, they will throw away a little more than 3,000 ejectors every year. Metal ejectors would eliminate this waste. Not to mention the cost savings!

“Plastic saliva ejectors are one of the instruments used by dentists that generate a big impact at the environmental level,” said Yulieth Segura Castillo, one of the students. “So we proposed a stainless steel, autoclavable, surgical-grade ejector to reduce this impact through a design that meets all of the conditions for professionals who decide to change from the usual plastic ejector.”

The dental students began their research and development process with several prototypes made out of various metals.

During the testing phase, some could not stand the heat, were deformed or failed during use. Next, they worked with a metallurgist to develop a final prototype that successfully passed all sterilization and functionality tests.

Although a metal saliva ejector will cost more than a plastic one, the students call the metal ejector a long-term investment. It will save dentists both the costs of buying thousands of plastic ejectors as well as the costs of disposing of them, since many waste companies that collect biological waste charge by weight.

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Kissing can ward off tooth decay

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Pucker up! It turns out kissing is good for you in more ways than you might think.

Most people know that kissing comes with loads of mental and physical benefits that make getting your smooch on totally worth it. From inducing an increase in happy hormones, including oxytocin, dopamine, serotonin, and a reduction in stress-causing cortisol, kissing is a great way to feel better — mentally, emotionally and even physically!

But science has even more to say about the benefits of a kiss. It turns out kissing can also help prevent cavities. No, really. It’s true.

It may not be as effective as flossing and brushing on a regular basis, but kissing increases the flow of saliva, which then helps prevent tooth decay.

Kissing is nature’s natural cleansing process. According to a study published by the Academy of General Dentistry, kissing stimulates saliva, which washes out the mouth and helps remove the cavity-causing food particles that accumulate after eating. Saliva’s mineral ions have been shown to even promote repair of small imperfections in tooth enamel.

Of course, more than a good-night kiss is needed to fully protect teeth. Besides, slacking on good oral hygiene would probably lead to fewer kisses anyway. So, keep up the daily dental hygiene regimen. And always brush and floss before going to bed, since sleep slows the production of saliva.

No one to kiss? We don’t recommend grabbing a stranger and laying one on. You can get saliva flowing in other ways like chewing gum, too (sugarless, of course).

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Dental professionals support raising legal age for purchasing tobacco to 21

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The American Dental Association (ADA) recently announced its support for a new bill that would raise the legal age to purchase tobacco products from 18 to 21.

The ADA praised lawmakers for introducing Senate Bill 1541, the Tobacco-Free Youth Act. “Preventing oral cancer and other tobacco-related diseases has been a longstanding priority for the ADA,” said ADA President Jeffrey M. Cole and Executive Director Kathleen T. O’Loughlin.

Did You Know?

Nearly 9 out of 10 people who die from oral and pharyngeal cancers use tobacco and the risk of developing these cancers is related to how much (and how often) they use. On average, 40% of those with the disease will not survive more than five years.

Tobacco products are also linked with higher rates of gum disease, periodontal disease, mucosal lesions, bone damage, tooth loss, jaw bone loss and more.

In a letter to lawmakers, the ADA noted the legislation would help prevent tobacco use among our youth by raising the national age to legally purchase tobacco products from 18 to 21 as well as help reduce the number of young people who begin smoking before age 21, which represents 95% of current adult smokers, according to the 2014 National Survey on Drug Use and Health.

E-Cigarettes Under Scrutiny

The bill would also apply to all the young e-cigarette users.

Research shows that young people who use e-cigarettes are much more likely to transition to smoking cigarettes. For that reason, the letter stated that the ADA does not consider these nontraditional tobacco products to be safer (or less harmful) alternatives to smoking.

The ADA has also joined a coalition led by the Campaign for Tobacco-Free Kids supporting the Reversing the Youth Tobacco Epidemic Act of 2019. That legislation addresses the e-cigarette epidemic and calls for the Food and Drug Administration (FDA) to implement health warnings for cigarette packages (including an oral cancer image) within 12 months.

If passed, the act also would raise the minimum age for purchasing non-traditional tobacco products such as e-cigarettes to 21 and prohibit non-face-to-face sales of all tobacco products, including e-cigarettes and e-cigarette accessories.

You can follow all of the ADA’s advocacy efforts on this issue at ADA.org/tobacco.

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Dentists invited to donate services to veterans

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There is more than one way to serve your country. If you’re a dental professional, you have the opportunity to use your unique skills and training to serve those who served our country.

In honor of the Memorial Day holiday, an organization called Dental Lifeline Network announced on May 14 that it is launching a volunteer recruitment campaign encouraging dentists to provide dental care to veterans, specifically those with special needs. Dental Lifeline Network is a nonprofit, humanitarian organization that provides access to comprehensive dental care for vulnerable people with special needs, the elderly, and those who are medically compromised.

The program is called “Will You See One Vet” and the campaign asks general dentists and specialists to volunteer and donate their services to help veterans through Dental Lifeline Network. From clearing up painful dental infections to being able to eat again — providing comprehensive dental care can make a life-changing difference for veterans.

Sadly, many veterans do not qualify for dental benefits. According to the U.S. Department of Veterans Affairs, veterans must meet certain eligibility factors in order to receive even routine dental care, such as a service-related dental disability or condition, or be a former prisoner of war.

The campaign utilizes imagery of veterans sharing their life-changing stories after receiving comprehensive dental care in targeted outreach, media and advertising. This includes a radio public service announcement that will run nationwide in donated time all month long.

“This awareness campaign showcases the life-changing difference our volunteers have made in the lives of veterans,” said Fred Leviton, CEO of Dental Lifeline Network, in a recent news release. “We hope sharing this message will inspire even more volunteers to participate in our program, allowing DLN to serve a greater number of veterans in our communities.”

Dental Lifeline Network is made up of more than 15,000 volunteer dentists and 3,500 volunteer laboratories.For more information on volunteering, visit WillYouSeeOneVet.org. To donate, visit dentallifeline.org/donate.

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Orofacial pain could become dentistry’s newest specialty

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For starters, let’s define orofacial pain. It will be helpful in understanding how (and whether) it might become dentistry’s newest specialty as recognized by the National Commission for Recognition of Dental Specialties and Certifying Boards’ review committee.

Orofacial pain is a broad term used to describe symptoms of pain and/or dysfunction in the head and neck region. Think headaches, jaw pain and much, much more. According to the American Academy of Orofacial Pain, orofacial pain is evolving and the scope of the field is enlarging.

Currently, orofacial pain encompasses:

  • Temporomandibular joint disorders
  • Masticatory musculoskeletal pain
  • Cervical musculoskeletal pain
  • Neurovascular pain
  • Neuropathic pain
  • Sleep disorders related to orofacial pain
  • Orofacial dystonias
  • Headaches
  • Intraoral, intracranial, extracranial and systemic disorders that cause orofacial pain

In early May, the American Academy of Orofacial Pain submitted an application and request to recognize Orofacial Pain as a dental specialty, which is now under review by the National Commission for Recognition of Dental Specialties and Certifying Boards’ review committee.

According to the National Commission, all documentation in the application is confidential until the review committee has determined that the application is complete. If the application is complete, the National Commission will invite public comment on the applicant’s compliance with the requirements for recognition for a 60-day period.

Specialties currently recognized by the National Commission include Dental Anesthesiology; Dental Public Health; Endodontics; Oral and Maxillofacial Pathology; Oral and Maxillofacial Radiology; and Oral and Maxillofacial Surgery.

The field of orofacial pain is concerned with the prevention, evaluation, diagnosis, treatment and rehabilitation of orofacial pain disorders, according to the AAOP website. Such disorders may have pain and associated symptoms arising from a discrete cause, such as postoperative pain or pain associated with a malignancy, or may be syndromes in which pain constitutes the primary problem.

The National Commission, at its March 11 meeting, revised its policies related to the application process requiring it to publish a notification to its communities of interest when an application has been received.

For more information on the National Commission on Recognition of Dental Specialties and Certifying Boards, visit ADA.org/en/ncrdscb or by calling 1-312-440-2697.

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The mechanism of caries and the anti-caries action of fluoride

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At present, around two-thirds of U.S. households have fluoridated water in their houses. The CDC has made nationwide fluoridation of drinking water a top priority for the prevention of cavities.

In 1945, Grand Rapids, Michigan, became the first U.S. city to implement community fluoridation of the water supply. Fluoride isn’t just found in tap water, of course. It’s also found naturally and fortified in certain foods.

Additionally, fluoride is a common ingredient in tooth varnish or gels, mouthwashes, prophy paste, and toothpaste, with an aim to reverse tooth decay.

How fluoride prevents cavities

We know our mouths house trillions of bacteria, which can form microcolonies on our teeth. When these microcolonies coalesce, it makes a layer of dental plaque.

However, bacteria have a hard time getting into the tooth because of the outer layer of the tooth, called enamel, which is made of a hard substance called hydroxyapatite. Hydroxyapatite is a type of calcium phosphate crystal with the chemical formula Ca10(PO4)6(OH)2.

When bacteria on the tooth surface start to grow, they break down sugar in foods and drinks and release acid as a waste product, which can cause the enamel to break down. Without hydroxyapatite, the tooth enamel can become weak and allow bacteria to enter, causing permanent damage — this is called a cavity.

If left untreated, the bacteria can infect the root of the tooth resulting in pain. This is where fluoride comes in.

Fluoride can replace the OH group in hydroxyapatite to create fluorapatite with the chemical formula Ca10(PO4)6(F)2. In general, fluorapatite is denser and less soluble than hydroxyapatite, so it’s less likely to demineralize. Fluorapatite is found in the strongest animals’ teeth.

Fluoride also accumulates in your teeth over time. So, while fluoride treatments are useful throughout your life, treatments are generally more important during childhood and adolescence. This is why fluoride varnish and gels for children are becoming more popular in recent days.

How fluoride treatments work

According to a meta-analysis that looked at 20 studies exploring the effects of fluoridation of drinking water on cavities in children, fluoride in the water leads to a 35% reduction of tooth decay in baby teeth and a 26% reduction in tooth decay of permanent teeth.

Another meta-analysis looked at 22 studies exploring the effect of applying a fluoride varnish to children’s teeth every 3 to 6 months at the dentist’s office found a 37% reduction in baby teeth and a 43% reduction in tooth decay in permanent teeth.

A third meta-analysis looked at 25 studies focusing on fluoride gel treatments given at least one time a year at the dentist’s office, generally to children older than 6 years old, which showed a reduction of 28% in tooth decay. A fourth meta-analysis looked at 35 studies that the effect of fluoridated mouth rinses given daily to every other week, and found a 23% reduction in tooth decay.

What the findings mean

If we look at meta-analyses of studies that focus on fluoridated toothpaste, it’s clear that it reduces tooth decay and that the effect is stronger with higher fluoride concentrations in the toothpaste, higher frequency of tooth brushing, and supervised brushing.

This was further supported by another meta-analysis that looked carefully at the amount of fluoride in the toothpaste.

This study showed that brushing with fluoridated toothpaste with a fluoride concentration of at least 0.1% prevents tooth decay in children and adolescents aged 16 years or less. There was a 23% reduction in tooth decay at concentrations of 0.1% to 0.125% fluoride and up to a 33% reduction in concentrations ranging from 0.24% to 0.28% fluoride.

Now, while fluoride can be toxic at doses well above those used for dental hygiene, the main concern with using fluoride has generally been fluorosis. Fluorosis is not a disease, but rather a cosmetic condition caused by overexposure to fluoride. Mild forms of fluorosis are common, with up to 41% of children and adolescents having some form of it.

It usually takes the form of subtle white patches on the teeth that are barely noticeable. In moderate to severe cases, which occur in less than 2-4% of the population, there can be significant mottling of the teeth with brown staining. While fluorosis is not generally a health concern, it can lead to social stigma.

A meta-analysis of 25 studies looked at whether brushing teeth with fluoridated toothpaste is linked to fluorosis and found that brushing the teeth of infants under 1 year old may increase the risk of fluorosis, but that relationship was weak.

There was a stronger relationship for children between the ages of 12 months and 6 years of age. If these children brushed with a toothpaste that was higher than 0.1% fluoride or more, they had a 30% chance of developing mild fluorosis.

This means that the risks of tooth decay, which are decreased over fluoride concentration of 0.1% fluoride or more must be balanced with the risk of fluorosis which increases fluoride concentrations over 0.1% fluoride.

Wrapping up

Tooth decay and dental cavities are leading health concerns around the world. In general, fluoridation of the water supply, and applying fluoride to the teeth via tooth varnishes, gels, mouth rinses, and toothpaste has helped decrease tooth decay.

While fluoride is generally considered safe at the concentrations used in fluoridated products, overexposure can lead to fluorosis. In some cases, risking fluorosis may be preferable to risking tooth decay in children at high-risk for tooth decay. So, it may be beneficial to discuss treatment options with your dentist.

In addition, the American Dental Association recommends preventing overexposure by brushing children’s teeth with only a grain-of-rice-sized smear of fluoridated toothpaste from when the teeth begin to erupt to about 3 years of age, and up to a pea-sized bead of toothpaste for children over 3 years old.

For children that are old enough to brush their own teeth, it’s also a good idea to monitor their brushing to decrease the likelihood that they swallow the toothpaste, which can also lead to overexposure and fluorosis.

The use of fluoride varnish in children could be even better as it may reduce the chance of frequent exposure to fluoride, thus reducing the risk of dental decay more than any other form of treatment.

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